tbuckley/cabot-search huggingface dataset:
Abstract 15414: Impact of Frequency and Duration of Atrial Fibrillation Events on Outcomes in Patients Undergoing Catheter Ablation
Authors: Arwa Younis, Oussama M Wazni, Hagai D Yavin, Jakub Sroubek, Ayman Hussein
Journal: Circulation (2022)

Introduction: Catheter ablation is a well-established treatment option for patients with atrial fibrillation (AF). We aimed to evaluate the impact of baseline AF events frequency, duration, and symptoms severity on AF recurrence Methods: The study included patients with first time AF ablation at a tertiary US center between 2013 and 2021. Patients prospectively completed a baseline and follow up survey (12 months) for patients reported outcomes assessing AF frequency, duration, and severity (AF symptom severity scale). The duration and frequency scores ranged between 0 and 9 (no AF to continuous). Patients were grouped into quartiles (Q1-Q4) based on their baseline scores. The quartile with the lowest score was used as the reference group. AF recurrence was assessed during follow up Results: A total of 2150 patients (age 65±9 yrs, 75% male, and 65% paroxysmal AF). At one year, only 17% of patients had AF recurrence. Frequency score: The risk for AF recurrence was similar between Q2/Q3 when compared with Q1 (Q2: HR=0.82, p=0.15, Q3: HR=0.98, p=0.91; Figure Upper), whereas patients in Q4 (score of 10) had a significant risk increase compared to Q1 (HR=1.28, p=0.047; Figure Left). Duration score: The risk for AF recurrence (Figure Middle) was similar between Q2 and Q1 (HR=0.97, p=0.83), was higher for Q3 (score ≥6 and &lt;9; HR=1.39, p=0.015), and highest for Q4 (score ≥9; HR=1.46, p=0.002). Severity score: The baseline severity score did not predict or correlate with AF recurrence during FU. Ablation resulted in a significant reduction (≥10%) in each score category. The highest benefit was seen among the Frequency category (96% of the patients had an improvement in their score at one year), followed by duration (90%) and severity (89%) Conclusions: Patients’ reported high frequency, and/or high duration were associated with increased risk for AF recurrence. Following ablation, improvement in all patients’ reported outcomes was significantly higher than reported AF free survivals
Abstract 14516: Systolic Slope of the Outflow Cannula Predicts Heart Failure Readmission Risk in Patients With Heartmate 3 Left Ventricular Assist Device
Authors: Nikhil Gupta, Mikail Siddiki, Ian Hackett, Anthony J Kanelidis, Alejandro Plana, Mark N Belkin, Maria Poonawalla, Roberto M Lang, Sean P Pinney, Valluvan Jeevanandam, Christopher Salerno, Jonathan Grinstein
Journal: Circulation (2022)

Introduction: Left ventricular assist devices (LVAD) may lead to left ventricular (LV) recovery in patients with heart failure with reduced ejection fraction (HFrEF) via LV offloading and subsequent positive remodeling. Current echocardiographic markers of LV recovery in LVAD patients are not well defined. The peak systolic slope, also known as systolic acceleration, of the outflow cannula has recently been shown to be a marker of underlying LV contractility and a tool to assess for LV recovery. We hypothesized that variations in the systolic slope would predict heart failure (HF) admissions. Methods: A total of 63 unique patients with LVAD at The University of Chicago Medical Center had HeartMate 3 (HM3) outflow tract Doppler signals obtained during routine transthoracic echocardiography (TTE) of suitable quality between 2015 and 2022. Systolic acceleration, systolic deceleration, diastolic acceleration, and the presence of flow reversal were measured. Mortality and HF admissions were recorded up to one year from the date of the TTE. Results: Increased systolic acceleration through the HM3 outflow cannula was associated with a decreased 1-year HF admission risk (352.8 [241.9, 515.8] cm/sec 2 vs 249.2 [164.0, 316.5] cm/sec 2 among readmitted patients, p = 0.03; Figure 1A). Systolic deceleration also predicted 1-year HF admission (-318.6 [-477.9, -244.0] cm/sec 2 vs -217.8 [-304.5, -188.8] cm/sec 2 among readmitted patients, p = 0.04; Figure 1B). Other variables, including the presence of flow reversal and diastolic acceleration, were not significantly associated with HF admission risk. Conclusions: Systolic acceleration, which reflects LV contractility, and systolic deceleration, which represents LV relaxation, are predictive of HF admission in patients with the HM3 LVAD.
Abstract 15869: Blood Pressure Trajectories Across the Life Course and Midlife Ventricular Systolic Function: The Bogalusa Heart Study
Authors: Ileana De Anda-Duran, Antonio Duran, Camilo Alonso, Lydia A Bazzano
Journal: Circulation (2022)

Introduction: Markers of adverse cardiac remodeling such as left ventricular (LV) hypertrophy and diastolic dysfunction have been associated with higher blood pressure (BP) during early and mid-life. Mid to late life hypertension is a well-known risk factor for left LV systolic dysfunction and progression to clinical heart failure (HF). We explore the association between BP in early to mid-life and LV systolic dysfunction measured by left ventricular ejection fraction (LVEF) in mid-life. Hypothesis: Higher BP in early to mid-life is associated with LV dysfunction as measured by LVEF. Methods: This complete-case analysis considered 1,140 participants of the Bogalusa Heart Study (57.5% female, 34.4% Black) with at least 3 traditional cardiometabolic risk factor (CMRF) observations since childhood (mean age 9.6±3.2 years) and transthoracic echocardiography-based LVEF estimations in midlife (48.9±5). Mean follow-up time was 38.6±3.8 years. A latent class trajectory modeling framework was employed to define trajectories of SBP. LVEF was divided into quartiles, and multivariable logistic regression models were utilized to estimate the association between life-course SBP trajectories and the lower quartile (Q1) of LVEF, controlling for traditional CMRF. Race, sex, and SBP trajectories interactions were tested to explore effect modification. Results: The prevalence of Q1 LVEF was higher among Black (32.1%, p&lt;0.01) and male (31.3%, p&lt;0.01) participants, compared to their counterparts. Four distinct trajectories were identified: stable-increasing (SI, 82.3%), moderate-increasing (MI, 5.2%), high-increasing (HI, 3.2%), and increasing-decreasing (D, 9.3%). Using SI as a reference, the following independent associations with the lower quartile of LEVF were identified: MI (OR: 1.4, 95%CI: 0.8 - 2.6, p=0.18), HI (OR: 0.72, 95%CI: 0.23-1.9, p=0.18), D (OR: 1.68, 95%CI: 1.1-2.6, p=0.02) Conclusion: Elevated systolic BP during early to mid-life (particularly 15-40 years of age) is associated with lower LEVF in midlife. These findings suggest the possibility of cardiac remodeling starting early in life. Increased awareness of elevated BP in childhood might be an avenue to prevent the progression to systolic dysfunction in late life.
Abstract 14808: Clinical Characteristics and Outcomes of Myocardial Infarction (MI) Among Patients With Chronic Kidney Disease (CKD): A National Inpatient Analysis
Authors: Oseiwe 'Benjamin' B Eromosele, Mayowa Adefuye, Abbas Alshami, Ikponmwosa G Ebengho, Ndausung Udongwo
Journal: Circulation (2022)

Introduction Cardiovascular disease, including myocardial infarction, is a common cause of morbidity and mortality among patients with chronic kidney disease (CKD), independent of other common cardiovascular disease risk factors. CKD has been linked to a systemic proinflammatory state contributing to myocardial and vascular remodeling resulting in atherosclerotic lesions, vascular calcification, and senescence. The clinical characteristics and outcomes of MI among patients with CKD has not been extensively studied nationally. Objectives To evaluate the clinical characteristics, including gender, race, and age; and outcomes, including in-hospital mortality (IHM), length of hospital stay (LOS), and complications post-MI among those with CKD. Methods Adults diagnosed with myocardial infarction and had background CKD were identified from the National In-Patient Sample (NIS) dataset for the year 2019 using the International Classification of Disease (ICD-10) codes. Weighted multivariable logistic regression models were used as appropriate. Various sociodemographic and clinical factors were adjusted for in the analysis. Results Of the 23,590 patients identified with MI and CKD; 65.1% were male, 69.6% were White, while the median age was 62 years (Inter-Quartile Range (IQR): 54-71) and 72 years (IQR: 63-81) in the non-CKD and CKD population respectively. The median LOS was 2 days (IQR: 2-4) and 3 days (IQR: 2-7) in the non-CKD and CKD group, respectively. The incidence of new intracardiac thrombus was lower at 0.2% among CKD patients vs. 0.4% among those without CKD (p: 0.108). Conversely, IHM was higher among those with CKD at 13.9% compared to those without CKD, who had an IHM of 6.7% (p: 0.0001). The incidence of heart failure was 49.3% among those with CKD, almost twice that of those without CKD at 23.6% (p: 0.0001). Conclusion This study highlights critical clinical characteristics and outcomes of MI in the CKD population. The results, especially regarding the age of onset of MI and the incidence of intracardiac thrombi, warrant further studies to unravel the reason(s) behind these findings.
Abstract 15325: Dynamic Change From Mitochondrial Compensation to Mitochondrial Failure During Aortic Disease Progression and Dissection Formation
Authors: Yanming Li, Zhen Zhou, Chen Zhang, Hernan Vasquez, Yang Li, Abhijit Chakraborty, Kimberly Rebello, Lin Zhang, Pingping Ren, Alon R Azares, Rui Chen, yumei li, Hong S Lu, Lisa A Cassis, Joseph S Coselli, Alan Daugherty, Scott A LeMaire, Dianna M Milewicz, Ying H Shen
Journal: Circulation (2022)

Introduction: Ascending thoracic aortic aneurysm (ATAA) progression to dissection (ATAD) is associated with a high risk of mortality. Since the specific molecular and cellular changes leading to dissection are poorly understood, we compared transcriptome profiles of aortic smooth muscle cells (SMCs) between ATAD, ATAA, and controls. Methods: We performed single-cell RNA sequencing (scRNA-seq) of ascending aorta tissues from patients with acute ATAD (dissected and non-dissected areas were collected separately, 3 women, 5 men) and ATAA without dissection (3 women, 4 men), and from control subjects without aortic diseases (transplant donors, 3 women, 5 men). SMCs clusters were analyzed and immunofluorescence staining was performed to confirm expression of key genes. Mice exposed to β-aminopropionitrile monofumarate (BAPN) starting at P21 were used to investigate the changes of mitochondria-related genes during disease progression in undissected mice. Results: Compared with controls, SMCs in ATAA exhibited an adaptive response characterized by upregulation of a subset of focal adhesion and contractile genes and a pro-fibroblast phenotype. These expression changes were decreased in SMCs in ATAD, which instead exhibited significant increases in genes for inflammatory response, glycolysis, senescence and cell death. Additionally, mitochondrial genes including tricarboxylic acid (TCA) cycle genes (e.g. SDHB , FH , and MDH2 ) and mitochondria genome genes (e.g. MT-ND4 , MT-CO2 , and MT-CYB ), exhibited increased expression in ATAAs, and downregulated in ATADs. Immunofluorescence staining of corresponding proteins confirmed some key findings. Consistent with human data, scRNA-seq showed increased mitochondria-related genes in SMCs in BAPN mouse model at P35 when aneurysms form, which were decreased in the proximal aortic tissues after the onset of dissection deaths in surviving mice at P42. Conclusions: Our data suggest a dynamic change from mitochondrial compensation to failure with progression from normal to aortic aneurysms to dissections, which ultimately increases cell death pathways.
Abstract 14615: Genome-Wide Association Study and Gene-Lifestyle Interaction of Dyslipidemia in Korean Population: Based on Gender Differences
Authors: GYEONG HEE LEE, Hae Yoo, HYEKYUNG JEON
Journal: Circulation (2022)

Introduction: Dyslipidemia is caused by the interaction between genetic variation and health-related lifestyle factors, and the incidences varies according to gender. The purpose of this study is to investigate the association between dyslipidemia-related single nucleotide polymorphisms(SNP) and health-related lifestyle factors in Korean cohorts. Hypothesis: We hypothesized that some SNPs affect the effects of lifestyle factors on the risk of dyslipidemia and analyzed gene-environment interactions to search interactive SNPs. Methods: Genotyping was conducted to determine genotypes of 72,298 people and investigate genotypes for 7,079,946 SNPs from Korean Genome and Epidemiology Study. We analyzed the effects of lifestyle factors such as diet, stress, physical activity, alcohol consumption, and smoking on dyslipidemia. After discovering SNPs with GWAS, the interaction between the SNPs and health-related lifestyle factors was confirmed. Results: Five SNPs were found to be associated with dyslipidemia in the entire cohort: rs117026536(LPL), rs651821(APOA5), rs9804646(APOA5), rs9926440(CETP), rs429358(APOE). In men, four SNPs were found to be associated with dyslipidemia, of which two were found only in men: rs662799(APOA5), rs56156922(CETP). Coffee intake and smoking experience had significant interaction with five SNPs in the entire cohort (p&lt;0.05; p&lt;0.05). SNPs of the LPL and the APOA5 showed significant interaction with drinking and exercising (p&lt;0.05; p&lt;0.05). Interestingly, there was a specific association between the risk of dyslipidemia and stress in men. rs662799(APOA5) showed significant interaction with stress (OR: 1.081, p=0.016). In addition, rs662799(APOA5) and rs56456922(CETP) had a significant interaction with the drinking period(p&lt;0.05). Conclusion: These results revealed a substantial interaction between lifestyle factors and the SNPs of APOA5 and LPL genes in hyperlipidemia in Korean population. Moreover, a specific association was found between rs662799(APOA5) and stress in Korean men. Since there is a significant interaction between genetic variation and lifestyle factors according to gender, further studies considering these characteristics are needed.
Abstract 13633: Differences in Right and Left Ventricular Remodeling After Tetralogy of Fallot Repair in Patients With and Without Pulmonary Valve Replacement
Authors: Karla Loss, John Wood, Jon A Detterich, Ramon Durazo-Arvizu, Luke M Wiggins, Paul F Kantor
Journal: Circulation (2022)

Background: Pulmonary valve replacement (PVR) is required to address residual lesions after tetralogy of Fallot repair (rTOF). We wished to determine the progression of ventricular dilation after rTOF, using cardiac magnetic resonance (CMR) data in children, to determine age related RV and LV volume differences in patients who did or did not require PVR. Methods: Single center, retrospective longitudinal study, including 214 patients with rTOF who had primary repair before 24 months and at least one CMR performed from 2000-2020. During follow-up, 142 patients (66.3%) had PVR at median age 12 years (IQR 9-15.5). Linear mixed effect modeling was used to evaluate time-related changes in ventricular volumes by log-transformed age at CMR adjusted for sex and regurgitant lesion status. Patients were grouped as per need for PVR during follow-up. Results: A total of 323 CMR from 201 patients performed before PVR were analyzed. The median age at first CMR was 9.4 years (IQR 5.9-12.3): 126 (62.7%) patients had one CMR, 34 (16.9%) had 2 and 41 (20.4%) had 3 or more. Prior to PVR there was steeper time-related RV dilation compared to non-PVR requiring patients: RVEDVi = 19.4 (CI 15.1 - 23.7) vs 2.8 (CI -2.5 - 8.2) ml/m 2 /log2year, p&amp;lt0.001; RVESVi = 11.9 (8.9 - 14.8) vs 0.8 (CI -2.9 - 4.4) ml/m 2 /log2year, p&amp;lt0.001. A time-related increase in LV volume also occurred in the PVR group compared to non-PVR: LVEDVi = 7.2 (CI 4.7 - 9.7) vs 1.5 (CI -1.6 - 4.6) ml/m 2 /log2year, p=0.005; LVESVi = 3.2 (CI 1.9 - 4.6) vs -0.4 (CI -2.1 - 1.3) ml/m 2 /log2year, p=0.001) (Figure 1). The factors associated with PVR were presence of regurgitant residual lesion, more prolonged QRS duration and transannular patch as surgical technique for TOF repair. Conclusion: Early and significantly increased progression of RV dilation and LV dilation are identifiable by CMR in patients destined to require PVR following rTOF. Early CMR surveillance may be indicated to permit early identification of progressive remodeling.
Abstract 15563: Analysis of the Ventricular Fibrillation Waveform Can Guide Resuscitation in Cardiac Arrest by Identifying the Precipitating Cause and Estimating the Underlying Hemodynamics
Authors: Anthony R Prisco, Marinos Kosmopoulos, Pierre Sebastian, Manan Gandhi, David G Benditt, Evangelos Theodorou, Demetris Yannopoulos
Journal: Circulation (2022)

Background: Patients presenting with out of hospital cardiac arrest (OHCA) and prolonged (&gt;30 min) cardiopulmonary resuscitation (CPR) face nearly 100% mortality. In patients presenting with ventricular fibrillation (VF), coronary ischemia is thought to be the cause in up to 60%. As conventional CPR does not reverse a coronary ischemia, CPR often must be done until a patient can be brought to a cardiac catheterization laboratory (CCL) where the underlying cause (acute ischemia) can be treated. In a porcine model of cardiac arrest, we have previously demonstrated that machine learning (ML) targeting invasive hemodynamic monitoring, could significantly improve CPR quality. To advance the clinical relevance of the machine-controlled CPR methods, we developed ML algorithms that can diagnose coronary ischemia during VF, and infer the underlying hemodynamics while performing CPR. Methods: In a porcine model of cardiac arrest, VF was induced via high-grade coronary occlusion (ischemia) or electrical stimulation (dysrhythmia). The animals (n = 72) were left in VF for 3 minutes prior to intervention and the ECG waveform was collected. The VF signal was converted to the frequency domain using a fast-fourier transformation and an ensemble classifier was developed to detect underlying ischemia. CPR was then initiated and the VF waveform was continuously monitored along with the coronary perfusion pressure (CPP). We then developed a 20-layer convolutional neural network (CNN) to non-invasively infer the CPP from a 10-second VF waveform. Results: Animal studies were split into training and test sets. When using the developed ML technique to detect ischemia from the VF waveform, evaluation of the test set yielded an area under the curve (AUC) of 0.81 on a ROC. When we used the CNN to infer the underlying hemodynamics, we demonstrated a high correlation between measured and predicted CPP in the test set. The AUC for the ROC when predicting a CPP of &gt;15 mmHg was 0.85. Conclusion: Survival for patients with OHCA secondary to coronary ischemia will improve with rapid diagnosis and high quality CPR. Our results demonstrate the proof-of-concept that the VF waveform contains features that can guide resuscitation for cause identification and hemodynamic improvement.
Abstract 14824: Life-Space Assessment Score is a Prognostic Factor in Older Adults With Cardiovascular Disease
Authors: Akihiro Hirashiki, Atsuya Shimizu, Manabu Kokubo, Kenichiro Nomoto, Izumi Kondo, Hidenori Arai
Journal: Circulation (2022)

Introduction: Older adults with cardiovascular disease (CVD) often have multiple comorbidities. However, to our knowledge, no studies have investigated the association between prognosis and life-space assessment (LSA) score, an indicator of the degree of use of the surrounding home and wider environments by patients, in older adults with CVD. The aim was to investigate whether LSA scores were associated with prognosis in older adults with CVD. Methods: Eligible subjects were aged over 65 years (average age 79.2 ± 7.6 years; left ventricular ejection fraction 56.7% ± 13.2%) and had been admitted to our hospital for worsening CVD. Receiver operating characteristic (ROC) analysis determined the cutoff LSA score (0-120 points, with higher scores reflecting greater life-space activity) in cardiovascular hospitalization. The calculated cutoff value was used to investigate the relationship between LSA score and cardiovascular events by survival analysis (Kaplan-Meier method) and Cox proportional analysis. The points at each level are totaled to achieve LSA scores from 0 to 120, with higher scores reflecting greater life space activity. Results: Over a 2-year period there were 44 cardiovascular hospitalizations and 10 cardiovascular deaths. ROC analysis revealed that the cutoff LSA score in cardiovascular hospitalization was 53.0 points (sensitivity, 55.9%; specificity, 82.1%, P = 0.003). Cardiovascular hospitalization and mortality rates were significantly higher in the low LSA group (P &lt; 0.001 for both, Figure ). Cox proportional analysis revealed that low LSA score was independently associated with cardiovascular hospitalization (hazard ratio; 2.540, 95% CI; 1.135 to 5.680, P = 0.023) and cardiovascular death (hazard ratio; 15.223, 95% CI; 1.689 to 137.180, P = 0.015), even after adjustment for age, sex, and log-transformed BNP level. Conclusions: LSA score is associated with prognosis in older adults with cardiovascular disease.
Abstract 15317: An Unusual Case of Recurrent Chest Pain: Lymphocytic Myocarditis
Authors: Muhammad Majid, Zachary S Yaker, Eunice S Dugan, Carmela D Tan, Paul C Cremer, Allan L Klein
Journal: Circulation (2022)

Case Presentation: A 42-year-old male with a past medical history of recurrent myopericarditis treated with a combination of NSAIDs, colchicine, and steroids presented for left-sided chest pain. The pain first recurred when he attempted a prednisone taper and he was started on Anakinra. Upon presentation, physical examination and laboratory findings were within normal limits. Echocardiography and electrocardiogram were within normal limits. Cardiac magnetic resonance imaging (CMR) showed transmural enhancement of the basal-mid inferolateral segments and patchy mid-myocardial enhancement in the basal-mid anterolateral segments. Nuclear medicine PET showed FDG uptake in the basal anteroseptal, anterolateral, inferolateral, inferior, and apical segments suggestive of active inflammation. Initially, the diagnosis was thought to be recurrent myopericarditis of unknown etiology. Subsequent right heart catheterization with endomyocardial biopsy (EMB) showed mononuclear infiltrates in the interstitium associated with myocyte infiltration and focal moderate interstitial fibrosis. Due to his clinical, imaging, and pathologic findings, he was diagnosed with lymphocytic myocarditis. His anti-inflammatory therapy regimen was reinstated, and he was started on Mycophenolate Mofetil. On follow-up, the patient had significant symptomatic improvement. Discussion: Lymphocytic myocarditis is a pattern of myocardial inflammation that is typically associated with autoimmune and idiopathic causes. Myocarditis frequently manifests with signs and symptoms of heart failure, including chest pain, dyspnea, and arrhythmias. Diagnosis of myocarditis is often supported by CMR and FDG-PET findings, however, EMB is the gold standard for the diagnosis of myocarditis. Treatment is generally supportive, though immunomodulatory therapies have gained increased popularity due to benefits in treating symptoms and preventing complications of heart failure.